Strategies for Increasing Medical Community Awareness of Audiology: A Call to Action!

Audiologists must educate physicians at every level and specialty, raise awareness of audiology and the importance of hearing health, and become an integral, if not interdependent, team member of PCPs and others who treat seniors. It is your professional responsibility.

With increased competition in the marketplace and changes in regulations allowing for over-the-counter (OTC) direct hearing aid sales to consumers, audiologists are becoming more dependent on hearing aid revenue as their main source of income. Thus, we quickly are realizing the urgency and need for increasing public and medical awareness of audiology.

Typically, audiologists receive little to no training in how to market their profession and differentiate themselves from the competition. Many audiologists expect their professional organizations to assume this responsibility and badger professional organizations to increase awareness of the profession. Professional organizations respond with pubic relations (media) and public awareness (consumers/public) toolkits, campaigns, and materials. Their well-intentioned efforts are an appreciated necessity, but not a sufficient cure for lack of awareness of audiology. What is missing is a dedicated and persistent effort by the individual audiologists acting locally to raise awareness.

We argue that it is the professional responsibility of individual audiologists to raise awareness of audiology and the importance of hearing health. Don't know how to do that? This article can help give you ideas and plans to start meeting this professional obligation.

Our contention is—increasing public awareness for audiology first requires increased awareness of the importance of hearing health. Increasing the awareness of hearing health requires the understanding and support of the medical community. Audiologists educating the local medical community is crucial to success. Enlightening the medical community about the necessity and superiority of audiological services is also a cost-effective and efficient approach to raising public awareness.

Focus on the Medical Community

People, time, money, and other resources for raising public awareness are limited. Most audiologists try to educate the public or potential patients, not physicians directly. We advocate educating the medical community as the more efficient and effective path to raising awareness. Here is why.

TABLE 1. There are far fewer primary-care physicians (PCPs) than potential patients for audiologists to educate.

Potential Patients

30–48 Million

Physicians

926,119

PCPs

441,735

Audiologists

12,000

People: As shown in Table 1, there are 30–48 million people with hearing loss, they are widely distributed geographically, and have no natural gathering or organization. That makes them difficult to reach. Patients often do what their physician recommends.

Physicians: Reaching out to educate physicians is a more efficient task than contacting potential patients. There are 926,119 physicians in the United States, which is less than one-thirtieth the number of potential patients, making the task less daunting. There are 441,735 primary-care physicians (PCPs) in the United States and about 12,000 audiologists seeing patients, or about 37 PCPs per audiologist.

Only 16.8 percent of physicians practice solo, and another 21.4 percent practice in a group of two to five physicians—the remaining 60.8 percent practice in groups of six or more. If we assume an average group size of six for PCPs, that results in about six PCP groups per audiologist. If each audiologist educates six such PCP groups, 97 percent (432,000) of PCPs would know the importance of hearing health and audiologists' role as the primary provider for hearing health.

Because physicians influence where patients receive diagnosis and treatment for hearing loss (Abrams Market Trac IX), educating PCPs will cause a tremendous increase in physician referrals and a significant increase in the number of patients with hearing loss diagnosed and treated by audiologists. Plus, audiologists would be fulfilling their professional responsibility.

There is another productive way to educate physicians and other relevant medical personnel. Auspiciously, they gather at professional meetings and in medical centers where education and continuing education courses are part of the routine. Audiologists must take an active role in educating physicians in these environments. This obligation is clearest for audiologists working in medical practices and in medical centers where the opportunities for educating physician and other relevant medical personnel are highest.

Education and Interdependency

Comparing adult and pediatric audiology, we see educating physicians and establishing interdependencies works well.

Integration with the Medical Community

The medical community serving adults is undereducated about the importance of early identification and consequences of adult hearing loss. Audiologists have failed to make themselves an integral part of the PCP team despite the growing number of senior patients. Pediatric physicians understand the importance of early identification and treatment of pediatric hearing loss. Audiologists work with pediatricians as an integral part of their team.

Mandatory Screening

Two to three of every 1,000 children (0.2–0.3 percent) are born with detectable hearing loss, and yet newborn hearing screening is required because physicians understand the link between hearing loss and language development in children. Strikingly, 15 percent of adults report some trouble hearing, and age is the strongest predictor of hearing loss. However, the only required screening for hearing loss and balance for seniors is for Medicare Part B beneficiaries in their initial "Welcome to Medicare" exam.

We question if that requirement is commonly practiced or enforced. Physicians do not understand problems caused by adult-onset hearing loss and benefits for early diagnosis. As with children, routinely required hearing screening for senior adults could provide a vehicle for physician and patient education and earlier diagnosis and treatment.

FIGURE 1. Because physicians most often practice in groups of six or more, if each audiologist educated six physician groups, 97 percent of PCPs would know the importance of hearing health and audiologists' role as primary provider for hearing health.

Audiologists guide, monitor, and provide pediatric hearing services until adulthood. Long-term adult care is arbitrary, often depending on how the patient enters the system.

Cochlear Implants

Adult cochlear implant (CI) audiology shows educating physicians and establishing interdependencies work just as well for adults as for children. CI surgeons work hand in hand with CI audiologists for diagnostics, follow-up programming, and rehabilitation. Audiologists are an important part of the CI team because CI surgeons learn the importance of audiologists during fellowship training to qualify as implant surgeons.

To Summarize

A higher percentage of patients with hearing loss are identified and treated in systems that have audiology as the primary-care provider such as pediatrics. For audiologists to become the primary-care provider for hearing loss, it is crucial that:

Physicians understand the importance of early identification and treatments for hearing loss for seniors as they do for children.

Audiologists achieve hearing health gatekeeper status in the medical community controlling the diagnostic, referral and follow-up processes in senior adults as they do for children and CI patients of all ages.

To employ audiologist-qualified, evidence-based, sophisticated diagnostic testing and rehabilitation for senior adults, as is done in pediatric audiology and CI audiology.

Audiologists must educate physicians at every level, raise awareness of audiology and the importance of hearing health, and become an integral team member of PCPs and others who treat seniors. It is your professional responsibility.

Different Approaches

Audiologists do well when integrated with physicians and have a solid physician referral source as in pediatric audiology, audiology in medical center ENT departments, and audiology with ENT in private practices. When establishing this integration and education, we must realize different environments lend themselves to different approaches. Below are examples of what to do in diverse settings.

Medical Center Audiologists

Audiology is already an integral part of ENT in many hospitals. In progressive hospitals like Henry Ford Hospital and the Mayo Clinics, audiologists are now the hospital- wide primary-care providers for adult hearing health care. How do we spread this concept throughout other medical centers?

Establish audiology as an integrated and crucial component to the success in the ENT department. Audiology and otology have an interdependent relationship. They rely on each other for success.

Present regularly at grand rounds and in other departments in the medical center to raise awareness.

Work determinedly to get hearing health an increased role in medical education, based on hearing health's growing prevalence and newly recognized importance to overall health and quality of life.

Increase efforts to get the importance of hearing and balance health a more meaningful place in an increased number of medical textbooks. Volunteer to co-author textbook chapters.

University medical center audiologists are best positioned to educate the medical community at all levels and specialties. Because they have the best opportunity to educate the medical community, they have a special professional responsibility to do so.

Private Practice and University Audiology Clinics

Standalone private practices and audiology clinics on nonmedical campuses have strong external competition, yet they depend mainly on friends and family referrals and marketing. They would gain a competitive advantage from physician education and regular physician referrals. They have the most to gain and should accept educating physicians as a routine professional responsibility. Here is how to accomplish that.

Primary-Care Physician Clinics

Visit local PCP clinics to educate them at least two to four hours per week. Great for the profession, beneficial for the practice.

We acknowledge that the audiologist in private practice or in the university setting may not have the bandwidth to commit precious hours to accomplish this. Universities may have a communications department wherein someone might already be in charge of community outreach and could distribute information regarding audiology targeting area physician practices.

An alternative solution, particularly for private practice audiologists, could be to hire someone part time with the skills and desire to interact in this manner. In addition, targeting certain practices instead of trying to reach all potential providers may be a more productive use of time. It is a fine line as the goal for private practice is to differentiate your practice from other competition. However, extolling your practice's virtues should not be coupled with negative comments of others, which could create negative associations and feelings of distrust about the profession.

Primary-Care Groups

A caveat regarding lunch and learns: the last thing we want is for you to feel as though you are wasting time, money, and effort to essentially feed an overworked staff for maybe a few minutes of face-to-face time with the office manager, physician, or physician assistants. It is important to assess the overall receptiveness of the office before blindly committing time and money to such an endeavor.

Audiology Students

Educate AuD students on the importance and responsibility of educating the medical community. Give them experience doing so.

Track your progress. How will you know if your hard work is paying off if you are not asking your patients why they decided to come in?

Nurture these relationships. To achieve long-term goals, consistency is required.

All Audiologists

Assume educating the local medical community as a high priority professional responsibility.

Publish in medical journals to increase visibility and stature of audiology.

Jointly present at local, state, and national medical meetings with a physician.

Pair with pediatricians, CI physicians, and ENTs who already work with audiologists as primary hearing health-care providers to convince other physicians it is the best model.

Audiology Professional Organizations

Audiology professional organization will accomplish more for the profession and patients if they pool their resources and work together on raising awareness. We recommend they jointly create and fund an independent nonprofit organization, the mission of which would be to raise awareness of audiology, the importance of hearing health, and to make audiologists hearing health gatekeepers and hearing health primary-care providers. As part of this mission, the organization would facilitate audiologists becoming interdependent team members of PCPs and others treating seniors. Here are a few projects such an organization could do to raise physician awareness:

Work with audiologists across the United States to staff booths and presentations at local, state, and national medical professional meetings to raise awareness of audiology and importance of hearing health, early diagnosis, and routine hearing health checks for Medicare annual wellness exams.

Constantly push education of the medical community about senior hearing health as a high priority and an urgent responsibility for the audiology profession.

Without waiting for audiologists to ask for them, regularly provide materials and content to audiologists and their business managers to educate the physician community and urge them to use the materials.

Make physician education and collaboration an integral and vital part of the AuD education program.

Suggested Topics

Medical, educational materials must be specific, free of jargon, grounded in evidence-based research and translated into quality patient care. Explain how the physician will benefit and deliver materials in a familiar format. Below are topics to try.

Why screening patients at an earlier age and intervening quicker in remediation and management of hearing loss will save an accountable care organization (ACO) money—right care, right provider, right place, right time.

Audiologists as an integral part of the physician's team of trusted advisors

The urgency for physicians and other health-care professionals to shore up their ability to communicate with older adults

Hearing loss as a triple threat to patients: (1) communication problems, (2) interference with a patient's ability to be treated for medical conditions, and (3) acceleration of some disabilities

The consequences of untreated hearing loss and untreated balance problems

The linkage between hearing impairment and numerous medical conditions

Why an audiologist is the first person your patient should see if his or her hearing changes

The wide range of evidence-based services provided by doctors of audiology

Why it requires a battery of tests to diagnose hearing loss and what each component adds

Why hearing aid fitting is complex and the benefits of doing it correctly

Why hearing aids are not like reading glasses

The role of the brain in hearing and hearing loss

The benefits of two ears versus one

Conclusion

Audiologists are quickly realizing the urgent need for increasing public and medical awareness of audiology. We propose that it is the professional responsibility of individual audiologists to raise awareness of audiology and the importance of hearing health, and that action by individuals at the local level will be most effective.

People, time, money, and other resources for raising public awareness are limited. Most audiologists try to educate the public or potential patients, not physicians. Increasing public awareness for audiology first requires an increased awareness of the importance of hearing health. Increasing the awareness of hearing health requires the understanding and support of the medical community. We advocate educating the medical community as the more efficient and effective path to raising awareness. To increase the number of people receiving needed diagnosis and therapy, it is a necessity.

Audiologists do well when integrated with physicians and have a solid physician referral source as in CIs, pediatric audiology, audiology in medical center ENT departments, and audiology with ENT in private practices. By observing CI processes and comparing adult and pediatric audiology, we know educating physicians and establishing interdependencies between audiologists and the medical community works to make audiologists the primary-care provider for hearing health and increases well-qualified referrals.

Audiologists must educate physicians at every level and specialty, raise awareness of audiology and the importance of hearing health, and become an integral, if not interdependent, team member of PCPs and others who treat seniors.

It is your professional responsibility. Without this effort, audiologists may find their profession outmaneuvered by the competition, and their patients turning to less-qualified, product, price, and profit-driven providers.

David Fabry, PhD, is the chief innovation officer for Starkey in Eden Prairie, Minnesota. He is the former editor-in-chief for Audiology Today.

Don Nielsen, PhD, is the founder of Don Nielsen Consulting, LLC, in Dublin, Ohio and Audiology University advisor for Fuel Medical Group in Camas, Washington.